This is a blog by a former CEO of a large Boston hospital to share thoughts about negotiation theory and practice, leadership training and mentoring, and teaching.

Sunday, January 27, 2008

On advertising

Your comments have been a little tame and complimentary lately, so it is time to throw some meat to the lions and stir up some discussion. This is about hospital advertising.

I opened up my latest version of Newton Magazine, a very nice local monthly publication edited by Jonathan Brickman that is targeted to one particular suburb of Boston. The ad on the inside cover is about an orthopaedic service offered by Newton Wellesley Hospital in collaboration with Massachusetts General Hospital. Page four has a full-page ad about diabetes from the Joslin Diabetes center. Page seven has a full page ad about heartburn and other digestive disease treatments at BIDMC. Then, of course, there are the smaller ads sprinkled through the magazine from practitioners in cosmetic dentistry, ophthalmic services, varicose veins, plastic surgery, concierge primary care, in-vitro fertilization, acupuncture, psychology, home care, assisted living, and cord blood banking. But for this post, let me focus on the hospital ads.

Putting on my consumer hat for a moment, I briefly had the same reaction that I have when I watch those drugs ads on television: Do these ads work? Well, we certainly know that the drugs ads work in creating demand for those products -- often to the dismay of doctors who do not really want to prescribe them. That has been documented.

To answer the question for hospitals -- "Do these ads work?" -- you need to consider their purpose. One purpose might be to encourage consumers to seek elective treatment for a condition about which they might not have considered treatment (e.g., that arthroscopic surgery for a knee injury) and another is to try to have them consider your particular hospital for the treatment they have chosen. Effectiveness for the first is hard to measure. Although insurance companies will tell you that many more people are seeking those elective treatments than ever before, it is hard to know if that is tied to marketing. Effectiveness for the second is equally hard to measure, although sometimes a hospital will be able to track a patient's initial phone call to a given ad.

Another purpose is to respond from pressure from your doctors and show them that you support their programs. Before I took this job, I talked with the head of a major Boston hospital who gave that as the primary reason for ads. "There is no evidence that ads work in creating business," he said, "but we need to keep our doctors happy." I have certainly felt that pressure in my place, and so I understand the desire to send a signal to your doctors -- who, after all, are essentially free agents who can easily change hospital affiliation -- that you support their practices.

Another purpose might be to educate the public about certain diseases and treatments. I think academic medical centers like to rationalize that they are offering this general benefit to the public in their ads, but, really, who would consider these one-page blurbs an effective means for such education?

I think the ads are posted mainly as a component of creating a broader brand identity. In this regard, hospital ads are remarkably similar to many other corporate ads. But unlike other industries that use it to drive sales, brand identity in the medical field is probably minimally important in generating and maintaining a sufficient level of clinical business. Perhaps more important, it helps create a mindset that the hospital has standing and stature and permanence in the community. This is important in attracting employees, enhancing physician recruitment and affiliations with other hospitals and physician practices, and generating interest from lay members of the community to serve on the hospital's governing bodies and to offer philanthropic support. These three purposes are actually fundamental to commercial viability in the health care world, especially for academic medical centers.

I would love to receive comments from other hospital administrators and marketing firms on what I have just said. And, of course, from the rest of you, too, who are now drooling at the prospect of offering a heartfelt opinion.

33 comments:

Paul - Your post focuses on traditional print, television or radio advertising for healthcare providers. I agree with you that these ads typically accomplish little in terms of health education or driving elective private pay patients to a particular provider that has pay mix/utilization targets. Traditional media ad results are hard to measure and are usually justified with "brand building" or "standing in the community" goals.

And, as an experienced colleague in the ad business frequently reminds me, major traditional media ad campaigns are often developed to meet ego needs of senior executives.(The elective procedure billboard advertising in Las Vegas and parts of Florida comes to mind.)

What if healthcare providers instead focused on establishing contextually relevant communication with health professionals, patrons and patients using targeted social media networks where the outcomes can be measured? (Dr. Val had a related thought in a comment response to me today.) Social media campaigns can be designed with creative that reaches large audiences (e.g. the recent Verizon FiOS campaign in the PA/NY market) *and* establish dialog that matches the context of audience.

A super point, Tom. As you note, I was referring to the traditional media. I totally agree with you about the prospects for social media, which can effectively reach more segmented audiences with contextually interesting information and messages -- and, by the way, at much lower cost. We have been engaging in that, as well, and I may cover that in a future post.

Check David Meerman Scott's blog and his book for a great exposition of these ideas.

In Health Care Renewal (http://hcrenewal.blogspot.com) we posted a few years ago by a study of advertising by academic medical centers published in the Archives of Internal Medicine (see post here: http://hcrenewal.blogspot.com/2005/03/how-academic-health-centers.html)

The article concluded that most ads were not reviewed by clinically knowledgeable people, made emotional claims, exaggerated benefits and minimized or avoided discussing adverse effects or down-sides or procedures.

The ads seemed more to serve the short-term marketing interests of the hospital than patients' needs. To a discerning viewer, fielding such ads might decrease the hospitals' reputations.

Just how much money are we talking about here? Aren't there cheaper (and more effective) ways to feed the egos of doctors and reach prospective donors than ads in glossy magazines and emotionally manipulative spots on 1030 (where sometimes I have to wait until the end to discern if the ad is for a drug company called Novartis or a hospital called something that is not Beth Israel)?

Chris Rowland at the Globe wrote a story on this on Feb 21, 2006. http://www.boston.com/business/healthcare/articles/2006/02/21/hospitals_blitz_airwaves_with_ad_campaigns/

An excerpt:

"We have world-class facilities all over this city, and the environment is more intense," said Peter A. Alemian, vice president for marketing at the Allen & Gerritson agency, which produces advertising for New England Baptist Hospital. ''The hospitals have taken it upon themselves to really let the public know what distinguishes them."

Advertising by hospitals in Boston media jumped to $18.4 million in the first 11 months of 2005, nearly four times the $4.8 million they spent in 2001, according to TNS Media Intelligence, a New York firm that tracks advertising by industry.

Massachusetts General Hospital and Brigham and Women's Hospital, which anchor the state's biggest care network, Partners HealthCare, spent the most money in 2005. Mass. General spent $1.5 million and Brigham and Women's spent $1.1 million.

(end of excerpt)

Most of us can't afford the Boston Globe. I think only one hospital system can, and does. Lots of hospitals use WBUR, which has the virtue of both reaching a great audience and helping another non-profit organization. Then, you will see many hospitals using the weekly local newspapers and monthly community magazines like the one I mentioned.

This may be completely naive but I seriously can't remember the last purchase I made because of advertising influence (I'm Gen Y). And if anything does have an influence on my purchasing decisions it is my social group or relevant elders.

Word of mouth advertising in health care is tremendously important. I haven't needed much in the way of health services since I moved from home to go to college. I have lived in two cities in those six years since and the biggest impact on my health services decisions is other people's opinions. One bad story about a hospital, or a bad experience, and I know I'm not going there. A good story goes a long way in influencing my decision.

The importance of hospital advertising, from my point of view, is its brand recognition. If I need health services from a hospital, the first place I am going to go is your website. Hopefully I have seen your hospital or your hospital's name once or twice and can remember it well enough to search it in Google. I guess in some weird way the presence of advertising may somehow correlate in the patient's mind with quality.

But as this industry continues to fracture and we are able to receive services at CVS, or the specialty hospital down the road, or the alternative/complimentary medicine place, or hospitals, advertising's importance is going to increase greatly. Maybe targeted social community advertising is the way to go, but I think it will be about easy access to information for those who are looking for it. We're not trying to convince anyone of the need for care (except maybe preventive services), they're coming to us with needs. I have visited quite a few hospital websites in the past week (ironically doing some research for a class project on the use of patient stories in hospital advertising). Most of them are amazingly difficult to navigate and it is extremely frustrating. Making hospital service information easy to understand (and navigate!) by the average consumer should be job number one.

But I think this still somehow comes down to the fact that consumers are unable to compare services at different hospitals because of the lack of information (quality, price, prior experience, etc.)

I hate all medical advertisements on TV. I don't like drug ads (aren't you constantly wondering "What was that medication FOR?", I don't like hospital ads either. One of the reasons is that it's unfair for some hospitals that have bigger bank accounts to push their services which may or many not be any better than the smaller hospitals that just can't afford the ads. You won't see an ad for St Elizabeth's, for example, but you do for the Brigham and for Mass Gen.

The weird thing for me is, all three of my cardiologists are in the Brigham ad, and ever time I see it I feel like waving to the TV. I'm sure that's not the purpose of the ad, but it's the only response I can come up with. And FWIW, I chose all my doctors well before that ad was ever filmed.

Paul, I don't think there's really much difference between the ads you're talking about and the BIDMC affiliation with the Red Sox. Both are about name recognition and keeping the BIDMC brand in the eye of the public. Maybe each targets a different "market segment" but both seem to me to have the same purpose. As someone who cares not a whit about baseball, I don't persononally get the Red Sox mystic (even after reading your blog entries about this issue last year). Seems like it's just one big business collaborating with another for mutual market benefit. And I would never pick a health care provider based on an ad. I'd rather see the money spent on all of this going to efforts to get providers to wash their hands!

We are saying the same thing in slightly different ways. I agree that there is not much difference between these ads and a sports team sponsorship, and that was exactly my point, both here and in my Red Sox post.

And, yes, all advertising is about mutual gain between the purchaser and the seller, or no one would do it in any field. And, as I suggested here, I also don't think most people pick a hospital based on ads. Most hospital visits result from referrals by particular doctors.

I was trying, in this post, to provide a cogent explanation for why many (perhaps most!) hospitals buy ads, and why they are viewed as important elements of the business strategy of these institutions.

But just one disagreement: It is a false comparison to bring up the hand-washing as an alternative use of money. That doesn't cost money. That involves getting people to change their habits. But, I get your point.

I'd love to hear from other hospital folks out there. (I know you are reading this: You can comment anonymously...)

In my major metropolitan area, there are a lot of big "community" hospitals but relatively few well known academic centers. There is much competition over cardiac services. We hear a lot of advertising (particularly radio) from various area hospitals touting either their long history in providing such services, or their high volume of cases, or their "experience", etc. I think this actually may affect prospective patients who may not have been aware of a particular hospital's expertise in this arena. However, when I had a young friend who needed a mitral valve repair, he, with the recommendations of his own cardiologist, the doctor friends of his nurse-wife, and myself(a physician), went to the Cleveland Clinic to have it done. So there.

My organization has run print ads recently in a few medical publications - solely because of our doctors. They love to see it & think it does wonders for business (it does not). We also have a group of our docs who think a billboard would make a huge difference. I am not looking forward to fighting that battle!

To keep my marketing budget in check, I try to feature the docs in publications like our annual report and quarterly newsletters. I then work hard to get those out in public places in the hospital and community, so they get the sense that we are putting that type of print advertisement out there.

I disagree with your statement: "Perhaps more important, it helps create a mindset that the hospital has standing and stature and permanence in the community."

When I see these types of ads on the T in Boston, I tend to think that the hospital doesn't have standing - why would a quality hospital need to advertise? We don't see top quality universities advertising their degree programs for PhD candidates and the like- we see nighttime programs that need to recruit to stay profitable.

I read your blog daily and I think that it may be the best advertisement for your hospital. Wouldn't it be great it you could declare that your marketing budget has been redirected into the quality improvement initiatives you so faithfully document?

You wrote:"It is a false comparison to bring up the hand-washing as an alternative use of money. That doesn't cost money. That involves getting people to change their habits."

I am not sure this is a false comparison. All marketing is about influencing behavior. You can try to influence our choice of hospitals or what we think of when we think of BIDMC (brand building). You can also try to influence our handwashing choices. One kind of marketing is external, the other is internal, but they are both marketing. And they both cost money.

In my neck of the woods, one of the major hospital systems has opted to do a series of commercials that bring the movie 'Coma' immediately to mind - or at least some horror movie. I don't think that was their intent. So, even if you are raising awareness, it might not be the awareness you want to be raised!

I am not a hospital administrator but a small town family physician with a deep cynicism about what "we" in medicine are selling.

http://poemd.blogspot.com/2007/03/demand-supply.html

And the highly paid CEO's seem to want to "lead" the way to Overtreatment, not health. So, make you docs happy(NOT) by analyzing their performance data. Measure and improve outcomes. Change physician behavior, not the "consumer/customer/patient". We are the highly trained guild with the leverage. Lean on us. That's where the impact can be the greatest.

It's hard to argue with all that has been said. As a 25 year health care marketing veteran, I really do not believe that advertising influences choice. By and large we are advertising services that 99 percent of the public DO NOT WANT and may not need for years. The only way you market to that is provide a great experience to the people you serve and find a way to intersect the non-healthcare interests of those who don't need you right now. I also believe that physicians need some serious marketing education. The knee jerk reaction I see of many hospitals advertising to keep up with the Jones' just wastes money. And in a time of tax exempt scrutiny advertising comes under the microscope. I further believe that this is the most visible sign that marketing has to show it is doing something and frankly the skill set of most marketing departments beyond advertising and some PR can not match other traditional industries. But I will leave it to a patient in a focus group I just conducted who said "I make a new choice every time." Even though she was loyal to that particular hospital that I was conducting the focus group about, every new condition brings for her a web search. If your hospital happens to be ranked in what she is looking for then she will take a look. If not she may never visit and may not even visit Web M.D. and Revolution. That is telling. And it gets back to the democracy of the web and how do you use it to create community and bring people, ambassadors, crusaders for your brand together. Thanks.

Paul -With all that you said in your post coupled with all of the comments that your faithful readers have left, it would be interesting to know your true opinion about marketing dollars spent at BIDMC. With tight budgets throughout the hospital, do you think keeping the physicians happy is reason enough to spend substantial dollars on advertisements? In other words, do you support the ads that BIDMC has placed in publications like Newton Magazine? Does boosting the egos of physicians justify not using these advertising dollars towards valuable equipment, additional nursing staff, and other factors that could increase quality of care? If it were solely up to you, how would you allocate BIDMC's marketing budget?

Over my 30+ year career in Health Care Management, I’ve worked in shops w huge marketing departments and others with none at all. Does marketing work, yes, and not really. IMHO, it depends on what is going on in your market. Back in the late 70's, early 80s, a great case study evolved in Columbia, Missouri, a university town which at the time had an academic medical center, a strong community hospital, and a 3rd hospital that was not quite as strong. What makes it interesting is that with few exceptions, Columbia is surrounded by farmland for 100+ miles in any direction. As the researchers would say, a wonderful control case.

Historically, nobody was advertising. Then one day, hospital A began a heavy advertising push including print, radio, and TV. Almost immediately market share shifted from hospitals B & C to A. Within six months Hospitals B & C were advertising also, and within another six months, market share had returned to levels that existed before anyone had spent a dime.

On the other hand in a metro area like you are in, keeping your image in front of folks is crucial, not only to remind the masses of the services you provide and the wonderful success stories that take place on a day to day basis, but also to remind them of the intrinsic value that you bring to your community. And, while it may also be partially off point, having a strong marketing presence is going to be crucial to counteract the negative corporate image campaign that SEIU has used and will continue to use in their effort to seek recognition at your facility.

Today there is an ad from the Texas Heart Institute in the Wall Street Journal. When the Cleveland Clinic, University of Pittsburgh Medical Center and the Texas Heart Institute regularly advertise in your service territory you have to respond. Maintaining your competitive advantage is required or someone else will be running a hospital.

So, both PL and midwest executive agree that they spend the "right" amount...What is necessary for market share.And I was trying to speak to a "higher purpose"...Health. It sounds like both hospital execs don't see much sense in pursuing health. Instead we pursue market share. Is health a reasonable goal? And is that what a hospital sells? My impression from this discussion is that a hospital sells MORE of itself. It is in the business of self perpetuation and growth, for it's own sake. It seems simple to me. Establish an arbitrary(thought out) goal of some kind that would be considered to reflect health, personal/community ( decreased ER visits, less pain med prescriptions, less asthma hospitalizations...I could go on)and spend your money on ads and measure. Do they accomplish improved health? Do they just stroke docs egos?If more evalution like this was being done in medicine I think we'd be spending less, doing less, and getting more.Instead we play the infaltionary game of the midwest case study.

Please see the January 17 post below -- http://runningahospital.blogspot.com/2008/01/source-material-on-quality-safety-and.html -- to understand what we are doing at BIDMC in terms of setting and achieving very aggressive goals for patient quality and safety in our hospital. Please note, too, that we will regularly be publicizing our progress towards meeting those goals, in what people consider a pretty remarkable commitment to transparency. We believe, with you, that this will result in better health care to the public, at a lower cost than what would otherwise take place. So that seems to be exactly what you are proposing. Indeed, it is a far cry from your assertion that we are not pursuing health.

That being said, as many have mentioned, there are compelling commercial reasons to advertise.

I am a physician, the lowly emergency physician, and will admit that the power of ego stroking WRT advertising is real. Both my husband and I have worked with the same health system for 20+ years. His services have been advertised on billboards, newspaper, and in-shop publications many many times. He would never admit it, but it does stroke his ego, and is at least a factor to mitigate his frustration with administration. In contrast, neither myself nor peers have been made mention in any such way. Of course, I would never admit it openly, but to be publicly appreciated would make me cry with joy.

Had to comment, though late. As a marketing person, employed by a hospital, my efforts go toward education and awareness. At a recent disease sponsored "walk" every major hospital was occupying a table with various give-aways, like luggage tags, antiseptic, tote bags, all with their logo printed on it. It was mayhem! Hospitals with strong marketing departments are smart, because consumers always have a choice. In my area, there are so many excellent programs for consumers to choose from, it makes sense to increase awareness.Unfortunately, I don't think consumers fully realize that hospitals are run as a business, and marketing services is common sense.

I stumbled upon your blog while - surprise surprise - looking for information on how hospitals do marketing/advertising campaigns. I work as the business development division head in a private tertiary hospital in the Philippines. Part of my function is to develop marketing strategies - including the development of ads.

Locally, major hospitals constantly pound patient-clients (as we call it) with information ranging from the strength of their doctors, to their new services, or to their quality certifications, etc. And because of this, they now retain consciousness in the minds of clients.

I agree with you that "brand identity in the medical field... helps create a mindset that the hospital has standing and stature and permanence in the community."It may not be the case anymore in the US as I observed in the previous comments; but, in the Philippines, if you ask someone on the street about their top of mind hospitals, it's likely the names of the hospitals who have almost inundated people with marketing communications.

But the marketing doesn't end there. Archaic as it may sound, the 4Ps of marketing still holds true. A good marketing communications plan should be grounded on good quality services offered.

I am quite impressed and amazed at the level of transparency that you have.

I don't see a need for hospitals to advertise. I don't want to pay for the advertising when I receive my bill. The change back to no advertising needs to come from the people who use the services. How do we socially pressure hospitals to put less or none of our medical payments out for advertising?

I totally agree with you on this. I'm a copywriter with a private hospital in Malaysia. As we all are aware, medical tourism is really booming nowadays in the Asian region. I've been asked to create ads that will literally sell the hospital and the services that we do. However, I do feel that along the way, we tend to miss out the real human touch in providing care. Of course we'll say that we care for the patient but it has become so stiff and stereotyped that it no longer generate the want and need to care for their health. I do hope that my ideas on ads that reflects future outcomes, such as the parents will be able to be at their son's graduation instead of saying that we have the latest technology to cure such illnesses, will be accepted by the bosses one fine day. Of course, those ideas will only be thrown into the bin as at the end of the day, they will only go for ideas that can generate revenues.

I entered the healthcare profession because of my experience from young dealing with my parents' health. They've been in and out of the hospital since I was in high school and that created the drive in me to produce ads and collaterals that will benefit others. Because I understand how frustrated it can be when no one explains it properly to you on what's going on with your parents.

It's really time that we ditch the conventional ads that only focuses on brandig and selling the services. I really wish that I can do the same but maybe I should start on a different approach when I present to the bosses. Thanks for the article Paul, you've opened my eyes on the real human touch when it comes to telling others on healthcare, not just another ad to sell on the services.